Endoscopic Versus Surgical Drainage of the Pancreatic Duct in Chronic Pancreatitis: Long-Term Outcome

Abstract

Background: Previously we have reported a randomized trial that compared endoscopic and surgical drainage of the pancreatic duct in patients with advanced chronic pancreatitis, which revealed a significant benefit of surgery after a 2-year follow-up. Five years later, the long-term outcome of these patients was evaluated. Methods: Between 2000 and 2004, 39 symptomatic patients were randomly assigned to undergo endoscopic drainage or operative pancreaticojejunostomy. In 2009, follow-up information was obtained regarding pain, physical and mental health, morbidity, mortality, length of hospital stay, number of procedures undergone, and pancreatic function. In addition, costs were evaluated. Analysis was performed according to an intention-to-treat principle. Results: During the 84 months of followup, one patient was lost to follow-up and seven patients died from unrelated causes. Of the endoscopically treated patients, 68% required additional drainage procedures, as opposed to 5% of the patients who underwent surgery (P=0.001) and the complication rate of endoscopic treatment was higher (74% vs. 37%, P=0.022). Overall, patients assigned to endoscopy underwent more procedures (a median of twelve vs. four, P=0.001). In addition, 47% of the patients in the endoscopic group were converted to surgical treatment. Although the Izbicky pain score difference in favour of the surgical group was no longer significant at the end of the follow-up period (39 vs. 22, P=0.12), surgery was still superior in terms of pain relief (80% vs. 38%, P=0.042). Physical and mental health, length of hospital stay, changes in pancreatic function, and costs were comparable. Conclusions: In the long term, surgery remains superior to endoscopic drainage of the pancreatic duct in symptomatic patients with advanced calcifying chronic pancreatitis. Importantly, almost half of the endoscopically treated patients were converted to surgery.